Acute Respiratory Illness in Patients With COPD and the Effectiveness of Influenza Vaccination

A Randomized Controlled Study

      Study objectives

      To determine the effectiveness of influenza vaccination on influenza-related acute respiratory illness (ARI) and overall ARI in patients with COPD, and its relationship to the degree of airflow obstruction.


      Stratified, randomized, double-blind, placebo-controlled trial.


      From June 1997 to November 1998 at a single university hospital.

      Patients and interventions

      One hundred twenty-five patients with COPD were stratified based on their FEV1 as having mild, moderate, and severe COPD. Within each group, they were randomized to the vaccine group (62 patients who received purified, trivalent, split-virus vaccine) or the placebo group (63 patients).


      The number of episodes and severity of total ARI, classified as outpatient treatment, hospitalization, and requirement of mechanical ventilation; and the number of episodes and severity of influenza-related ARI.


      The incidence of influenza-related ARI was 28.1 per 100 person-years and 6.8 per 100 person-years in the placebo group and vaccine group, respectively (relative risk [RR], 0.24 [p = 0.005]; vaccine effectiveness, 76%). The incidences were 28.2, 23.8, and 31.2 per 100 person-years in the patients with mild, moderate, and severe COPD, respectively, in the placebo group, and 4.5, 13.2, and 4.6 per 100 person-years in the patients with mild, moderate, and severe COPD, respectively, in the vaccine group (RR, 0.16 [p = 0.06]; vaccine effectiveness, 84%; RR, 0.55 [p = 0.5]; vaccine effectiveness, 45%; and RR, 0.15 [p = 0.04]; vaccine effectiveness, 85%, in the patients with mild, moderate, and severe COPD, respectively). Bivariate analysis revealed that the effectiveness of influenza vaccination was not modified by the severity of COPD, comorbid diseases, age, gender, or current smoking status. There was no difference in the incidence or severity of total ARI between the placebo group and the vaccine group.


      Influenza vaccination is highly effective in the prevention of influenza-related ARI regardless of the severity of COPD. Influenza vaccination does not prevent other ARIs unrelated to influenza. The effectiveness of influenza vaccination in the prevention of overall ARI in patients with COPD will depend on how much the proportion of influenza-related ARI contributes to the incidence of total ARI. Influenza vaccination should be recommended to all patients with COPD.

      Key words


      ARI (acute respiratory illness), GMT (geometric mean titer), HI (hemagglutination inhibition), RR (relative risk)
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        • Murray CJL
        • Lopez AD.
        Evidence based health policy: lessons from the global burden of disease.
        Science. 1996; 274: 740-743
        • Niederman M.
        COPD: the role of infection.
        Chest. 1997; 112: 301S-302S
        • Seneff MG
        • Wagner DC
        • Wagner RP
        • et al.
        Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease.
        JAMA. 1995; 274: 1852-1857
        • Carilli AD
        • Cohd RS
        • Gordon W.
        A virologic study of chronic bronchitis.
        N Engl J Med. 1964; 270: 123-127
        • Gump DW
        • Phillips CA
        • Forsyth BR
        • et al.
        Role of infection in chronic bronchitis.
        Am Rev Respir Dis. 1976; 113: 465-470
        • Rothbart PH
        • Kempen BM
        • Sprenger MJW.
        Sense and nonsense of influenza vaccination in asthma and chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 1995; 151: 1682-1686
        • Smith CB
        • Golden C
        • Klauber MR
        • et al.
        Interactions between viruses and bacteria in patients with chronic bronchitis.
        J Infect Dis. 1976; 134: 552-561
        • Fainstein V
        • Musher DM
        • Cate TR.
        Bacterial adherence to pharyngeal cells during viral infection.
        J Infect Dis. 1980; 141: 172-176
      1. ATS statement: standards for the diagnosis and care of patients with chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 1995; 152: S77-S120
        • Siafakas NM
        • Vermeire P
        • Pride NB
        • et al.
        ERS consensus statement: optimal assessment and management of chronic obstructive pulmonary disease (COPD).
        Eur Respir J. 1995; 8: 1398-1420
      2. The COPD Guidelines Groups of the Standards of Care Committee of the BTS: BTS guidelines for the management of chronic obstructive pulmonary disease.
        Thorax. 1997; 52: S1-S28
        • Foster DA
        • Talsma A
        • Furumoto-Dawson A
        • et al.
        Influenza vaccine effectiveness in preventing hospitalization for pneumonia in the elderly.
        Am J Epidemiol. 1992; 136: 296-307
        • Nichol KL
        • Margolis KL
        • Wuorenma J
        • et al.
        The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community.
        N Engl J Med. 1994; 331: 778-784
        • Govaert TM
        • Thijs CT
        • Masurel N
        • et al.
        The efficacy of influenza vaccination in elderly individuals: a randomized double-blind placebo-controlled trial.
        JAMA. 1994; 272: 1661-1665
        • Barker WH
        • Mullooly JP.
        Influenza vaccination of elderly persons: reduction in pneumonia and influenza hospitalization and deaths.
        JAMA. 1980; 244: 2547-2549
        • Riddiough MA
        • Sisk JE
        • Bell JC.
        Influenza vaccination: cost-effectiveness and public policy.
        JAMA. 1983; 249: 3189-3195
        • Howells CHL
        • Tyler LE.
        Prophylactic use of influenza vaccine in patients with chronic bronchitis.
        Lancet. 1961; 30: 1428-1432
        • Fell PJ
        • O'Donnell HF
        • Watson NP
        • et al.
        Longer term effects of influenza vaccine in patients with chronic pulmonary disease.
        Lancet. 1977; 18: 1282-1284
        • Howells CHL
        • Vesselinova-Jenkins CK
        • Evans AD
        • et al.
        Influenza vaccination and morbidity from bronchopneumonia in the elderly.
        Lancet. 1975; 1: 381-383
        • Gross PA
        • Patriaco D
        • McGuire K
        • et al.
        Relation of chronic disease and immune response to influenza vaccine in the elderly.
        Vaccine. 1989; 7: 303-308
        • Anthonisen NR
        • Wright EC.
        Bronchodilator response in chronic obstructive pulmonary disease.
        Am Rev Respir Dis. 1986; 133: 814-819
      3. Thai guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease.
        Thai Thoracic Society, Bangkok, Thailand1996: 1-28
      4. Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Recomm Rep. 1996; 45: 1-24
        • Eadie MB
        • Stott EJ
        • Grist NR.
        Virological studies in chronic bronchitis.
        BMJ. 1966; 2: 671-673
        • Anthonisen NR
        • Manfreda J
        • Warren CP
        • et al.
        Antibiotic therapy in exacerbation of chronic obstructive pulmonary disease.
        Ann Intern Med. 1987; 106: 196-204
        • Storch CA.
        Respiratory infections.
        in: Storch GA Essentials of diagnostic virology. Churchill Livingstone, New York, NY2000: 59-78
        • Thawatsupha P
        • Maneewong P
        • Prasittikhet K
        • et al.
        Local strain influenza viruses isolated during the period 1998–1999.
        J Health Sci. 2000; 9: 551-557
        • Barker WH.
        Excess pneumonia and influenza associated hospitalization during influenza epidemics in the United States, 1970–78.
        Am J Public Health. 1986; 76: 761-765
        • Nichol KL
        • Wuorenma J
        • von Stenberg T.
        Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens.
        Arch Intern Med. 1998; 158: 1769-1776
        • Nichol KL
        • Baken L
        • Nelson A.
        Relation between influenza vaccination and outpatient visits, hospitalization, and mortality in elderly persons with chronic lung disease.
        Ann Intern Med. 1999; 130: 397-403
        • Gross PA
        • Hermogenes AW
        • Sacks HS
        • et al.
        The efficacy of influenza vaccine in elderly persons.
        Ann Intern Med. 1995; 123: 518-527
        • Doraisingham S
        • Goh KT
        • Ling AE
        • et al.
        Influenza surveillance in Singapore: 1972–1986.
        Bull World Health Organ. 1988; 66: 57-63
        • Rao BL
        • Banerjee K.
        Influenza surveillance in Pune, India, 1978–90.
        Bull World Health Organ. 1993; 71: 177-181

      Linked Article

      • Influenza Vaccination in Vulnerable Populations
        ChestVol. 125Issue 6
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          People with asthma and COPD are considered to be at risk for complications of influenza. This disease has been responsible for a major increase in morbidity and mortality during epidemic periods, especially in such patients. As early as 1848, the founder of modern concepts of medical surveillance, William Farr, estimated that 41% of the population of London died due to bronchitis or pneumonia.1 Each year, an average of 20,000 people die of influenza-related illness in the United States.2 Influenza and pneumonia were the seventh leading cause of death in 2000.
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